tag:blogger.com,1999:blog-20056539.post325287556970703718..comments2015-08-01T05:03:08.636-07:00Comments on Movin' Meat: Why Patients are Not Consumersshadowfaxhttp://www.blogger.com/profile/11648279307230813762noreply@blogger.comBlogger65125tag:blogger.com,1999:blog-20056539.post-10926998213212685232011-05-08T09:37:24.204-07:002011-05-08T09:37:24.204-07:00NO mention in original post of the abuse of the 91...NO mention in original post of the abuse of the 911 system and it&#39;s astronomical end-cost(ER visits for what should be clinic/Dr. office appts.etc.), but of course we are only looking at one side of this question-I mean, God forbid we actually take some personal responsiblity, right? Let&#39;s not start holding the people who contribute nothing to pay for their healthcare accountable for their abuse and the resulting costs of it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-59673486937822172642011-05-02T12:11:54.650-07:002011-05-02T12:11:54.650-07:00Not sure how you got from A to B there. When you a...Not sure how you got from A to B there. When you are hungry, you can choose not to eat, but increase your chances of death. Free market principles seem to apply to food, though.Bob Lhttp://www.blogger.com/profile/10075996192815961493noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-42667975109477139422011-05-02T10:02:50.812-07:002011-05-02T10:02:50.812-07:00Outstanding discussion
The key to me is a reitera...Outstanding discussion<br /><br />The key to me is a reiteration your first point:<br />medical problems are essentially coercive-- when you get sick, you can choose not to have care, but greatly increase your chance of death. Therefore, &quot;free&quot; markey principles do not apply.Dr Sethhttp://www.blogger.com/profile/11511273712090189564noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-52590058812771728882011-04-29T17:00:58.952-07:002011-04-29T17:00:58.952-07:00&quot;I&#39;d also like to add that regulation cre...&quot;I&#39;d also like to add that regulation creates warped incentives ...But because insurance doesn&#39;t reimburse for nurse care but only for face-to-face (&quot;butt in seat&quot;) doctor visits, it&#39;s often a year or more until diabetes patients are properly dosed.&quot;<br /><br />That isn&#39;t an example of that is an example of private industry rules.<br /><br />The very first time I needed medical care as an adult, I spent two days in the hospital, not because I needed to be hospitalized, but because the doctor knew my insurance would pay for tests she wanted to do only if I were in the hospital. That was in 1974, and things haven&#39;t improved. I still want to believe she did it because I wouldn&#39;t have gotten treatment otherwise - but she wouldn&#39;t have gotten paid, either, since I could barely afford food at the time, and wouldn&#39;t have paid for tests or treatment - it was mono, for which there still isn&#39;t any treatment other than relieving symptoms.<br /><br />Insurance rules distort many treatment decisions. I see no difference in the government or insurance companies making those rules, except, of course, the government has no profit to maximize. So it is in the government&#39;s interest to manage the rules to maximize health to lower, but not necessarily the insurance companies&#39;.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-28029263492250131102011-04-29T11:13:09.529-07:002011-04-29T11:13:09.529-07:00I&#39;d also like to add that regulation creates w...I&#39;d also like to add that regulation creates warped incentives that, in some medical sectors, is clearly worse for the consumer (in others they are also worse, but not so clearly). For example, diabetes treatment requires many visits to properly adjust the dosages of insulin/medicine, and are therefore most efficiently administered by nurses. But because insurance doesn&#39;t reimburse for nurse care but only for face-to-face (&quot;butt in seat&quot;) doctor visits, it&#39;s often a year or more until diabetes patients are properly dosed.nyctonolanoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-21670540779107950652011-04-29T11:10:59.864-07:002011-04-29T11:10:59.864-07:00His main point (that market forces don&#39;t affec...His main point (that market forces don&#39;t affect health care consumption) is clearly wrong, but he obfuscates it by not looking where this is obvious, i.e. the increased services demanded by those who don&#39;t pay for their health care (e.g. emergency rooms in poor areas vs. richer areas). He asserts that health care is cut and dry (&quot;you get pneumonia&quot;, &quot;your knees wear out&quot;, &quot;you get a lump on your breast&quot;), but it&#39;s not usually that obvious. For those things he does mention, catastrophic insurance would be ideal. Nor does he mention that there are a variety of potential remedies and they have different costs -- do you get the name-brand or the generic? Do you get the aluminum knee or the titanium-graphite one? Do you get the best surgeon on earth or do you get a good surgeon at your local hospital? These are all issues that are distorted upwards in price if there is no incentive to economize.<br /><br />His point regarding asymmetry of information applies to all markets, including the successful ones. It is not specific to health care and therefore there is no reason to think that it would be a problem in that particular market when it isn&#39;t in others. Furthermore, he bemoans things like lack of price transparency when this is a result of the regulations, not the market.<br /><br />His third point analyzes the distribution of medical services/costs IN THE CURRENT SYSTEM, with the sky-high prices currently in place due to market distortions, and assumes these would be the prices under a free market (&quot;...I doubt it would make one iota of difference in the actual cost...). He furthermore assumes that medical care is a right and that inability to pay should be no impediment to receiving services. It isn&#39;t and it should.nyctonolanoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-11429563020289003802011-04-28T11:37:47.600-07:002011-04-28T11:37:47.600-07:001. Health care is generally not a refusable or ele...<i>1. Health care is generally not a refusable or elective service.</i><br /><br />True, but I don&#39;t see what that has to do with anything. Food, shelter and clothing aren&#39;t elective, either, but there&#39;s a market for them.<br /><br /><i>2. There is an asymmetry of information</i><br /><br />I absolutely agree. The health care industry is riddled with obfuscation. Providers bill one amount but accept a smaller amount as payment in full. The cost of care is often split between the patient and an insurance company (possibly the government). And the cost of insurance is often split between employers and employees. The end result is that the consumer often has no idea what they&#39;re really paying for any of it. If that&#39;s not a recipe for runaway inflation, I don&#39;t know what is.<br /><br /><i>3. Purchasing power is concentrated in the hands of a very small number of &quot;consumers&quot;</i><br /><br />Your data do not support this conclusion. Your data indicates that the vast majority of <b>spending</b> is concentrated on a very small number of patients. However, those patients do not necessarily wield the purchasing power. For the reason why, see above.<br /><br />If we really want to know why the cost of health care is increasing so much, perhaps we should ask the government. After all, the government is, by far, the largest purchase of health care in the United States. Almost half of all health care in the United States is paid for by the government. Talk about lack of incentive to contain costs.Bill Woessnerhttp://www.blogger.com/profile/08919844120431095879noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-14098634699041315452011-04-25T13:25:13.588-07:002011-04-25T13:25:13.588-07:00Are you familiar with the RAND health insurance st...Are you familiar with the RAND health insurance study?Wonks Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-31518927117801984962011-04-25T12:52:14.414-07:002011-04-25T12:52:14.414-07:00Great post!Great post!Jolly Greenhttp://www.blogger.com/profile/09631364433925344569noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-75281880786888499242011-04-25T11:41:15.360-07:002011-04-25T11:41:15.360-07:00I disagree. For major medical intervention, you a...I disagree. For major medical intervention, you are undoubtedly right, but there is far too much unnecessary medical care being sought simply because the patient/consumer has nothing to lose by seeking it. When you blow a head gasket on your car, you do need a mechanic, but is it necessary to go to the garage when your tires are low? <br /><br />I have pretty good health care coverage, but I nevertheless treat it like i have skin in the game, maybe because of a built in distrust of doctors. A few years back, I broke a couple of ribs in separate incidents. In my martial arts studio, one of my peers, a doctor, suggested I should get then x-rayed. My response was, &quot;And then what?&quot; They&#39;re broken. There&#39;s no treatment. And sure enough on schedule after 6 weeks and a day the pain went away. More recently I broke a toe at work - just the tip, nothing medically to be done. OSHA required me to seek treatment, but follow ons was optional, and I declined. Currently, I&#39;m self-treating a case of Plantar Fasciitis, support tape, rest, elevation, stretching. All the things a doctor would charge my insurance a lot of money to tell me to do.<br /><br />Why should a patient sit still for a $4000 MRI in a hospital, when he can go 5 miles down the road and get exactly the same scan done for $600 at Open Advanced MRI? But with health insurance paying for it, this alternative is never proposed.<br /><br />On the flip side, I do know when to seek medical help. I didn&#39;t hesitate when I realized that red spot on my head was probably skin cancer, and it was, and now it&#39;s gone. Skin in the game, literally.<br /><br />My point is that there&#39;s no sense in seeking a medical opinion that essentially amounts to &quot;Gee, that must hurt!&quot; and being sent home with an overpriced bottle of Ibuprofen. But if you make it free to the consumer, you will get unnecessarily expensive abuse.Scruffy Sciroccohttp://www.blogger.com/profile/08052356705555455175noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-20826783847187856422011-04-25T10:31:31.941-07:002011-04-25T10:31:31.941-07:00One question. Hasn&#39;t the medical industry bee...One question. Hasn&#39;t the medical industry been moving in the direction you seem to support (ie the patients bearing less out of pocket expenses as a percentage of medical costs). If so, why are health care costs out of control? There must be some other much larger force at work. So answering that question would seem to be a much better use of your time.<br /><br />Of course there is an alternate explanation. Perhaps your rationalizations and anecdotal evidence notwithstanding you are wrong. Nah... you&#39;re a doctor and smart and stuff... couldn&#39;t be...Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-67297830924725555802011-04-25T05:47:46.381-07:002011-04-25T05:47:46.381-07:00God bless you Doctor. As a health care consultant ...God bless you Doctor. As a health care consultant for large employers, our data is an exact mirror of yours. Here&#39;s the other side--The Dem&#39;s vision of a Castro style health utopia is just as stupid as the right&#39;s CDHP warped vision. Here&#39;s my partner&#39;s cost-shifting editorial. <br />http://tinyurl.com/3ultm6rDanhttp://www.blogger.com/profile/12098137369155674234noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-23675541338010069162011-04-24T20:46:22.198-07:002011-04-24T20:46:22.198-07:00Vince
&quot;Second, that somehow health care deci...Vince<br /><br /><i>&quot;Second, that somehow health care decisions should be taken out of the hands of doctors, patients, and families and put in the hands of the state. While this wouldn&#39;t mean &quot;death panels&quot; as some claim, it will mean that people are allowed to die because it&#39;s not worth the money to save them.&quot; </i><br /><br />That&#39;s a frequently repeated <b>&quot;talking point&quot;</b>. Did you intentionally leave the words &quot;Insurance Companies&quot; out of that first sentence? <br />In your last paragraph you suggest that the majority of care is paid by insurance. They are part of the decision making process, and of course they have been known to decline claims.<br /><br />My wife works at a local cancer care facility, if private insurance or medicaid / medicare refuses coverage the results are exactly the same. Patients don&#39;t feel any better dying under private insurance, and in fact they and their families worry a lot more about private insurance denying / delaying care. <br /><br /><br />And why would a state or federal enterprise be less ethical than a &quot;for profit one&quot; ?ExPatBritnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-72518039104803807142011-04-24T17:42:03.302-07:002011-04-24T17:42:03.302-07:00VinceRN
That&#39;s a staggering display of ignora...VinceRN<br /><br />That&#39;s a staggering display of ignorance and I didn&#39;t even read past the first sentence. <br /><br />Germany and France eat our lunch in cost and quality every day, year in, year out. Go read.Christopher M. Hughes, MDhttp://www.blogger.com/profile/04897385081996317145noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-7661052224954024372011-04-24T17:13:31.309-07:002011-04-24T17:13:31.309-07:00I have to say that I completely agree with your pr...I have to say that I completely agree with your premise, that patients are not consumers, and you make some excellent points. I don&#39;t believe that market economics can or should be used in theheatlh care arena. As a clinician, I don&#39;t know if I want my patients to be &quot;consumers&quot; and, in any case, my services come with the room charge, so that doesn&#39;t even make sense. As a patient, I don&#39;t want to be a consumer either. I want to be a patient. My question is what do we do with chronically ill patients who could make better health and lifestyle choices, but don&#39;t? These are the patients who come into the hospital repeatedly, spend weeks in the hospital, and are discharged to inadequate situations, only to return to the hospital a few weeks or months later. These are the patient who likely make up a good portion of the top healthcare spenders.hospitalRNnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-12623747063010054962011-04-24T16:21:45.389-07:002011-04-24T16:21:45.389-07:00Fantastic post. I have a guestion for all the doct...Fantastic post. I have a guestion for all the doctors, who write orders for screening mammograms. Why 90 years old women needs one? If the results become positive,is she going to go under chemo,or rad.therapy? What obout the patients,who are in the whilchairs,whith oxygen tanks,not being to able to even recognize,that they are in the mammography room. Do You know,why they come? Because the Dr. told them so.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-79049209262917411632011-04-24T10:43:39.175-07:002011-04-24T10:43:39.175-07:00A lot of people commenting here seem to believe a ...A lot of people commenting here seem to believe a couple off odd things.<br /><br />First, that somehow a government bureaucracy would operate more responsibly, efficiently and ethically than a private entity. There is no evidence of that anywhere in all of the world, in fact there are mountains of evidence of just the opposite, yet many of you seem to believe it.<br /><br />Second, that somehow health care decisions should be taken out of the hands of doctors, patients, and families and put in the hands of the state. While this wouldn&#39;t mean &quot;death panels&quot; as some claim, it will mean that people are allowed to die because it&#39;s not worth the money to save them. <br /><br />I don&#39;t trust the state nearly enough to give them that kind of power.<br /><br />As for Shadowfax&#39;s blog post, he&#39;s broadly correct, patient&#39;s are not consumers, they are patients. Sure, he has a political slant and the data is massaged a little to support that slant, but his thesis is correct, health care, or at least most of it, the way we want to have it in America, is not controlled by market economics.<br /><br />Only those patients that self insure, that are spending their own money, can be called consumers. I think I&#39;ve met two of those in my twenty something year career in ER and EMS.VinceRNhttp://www.blogger.com/profile/15060544999251834729noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-30259514327707130232011-04-24T09:12:50.361-07:002011-04-24T09:12:50.361-07:00arthroscopic meniscectomy no better than a placebo...arthroscopic meniscectomy no better than a placebo? you know how many of these things i scrub? ditto for lumbar discectomy which i heard the same thing about. the best thing government-controlled healthcare can do is bring these things to light and not pay for them. the only way to save money for the good of all is to ditch things that show little benefit or don&#39;t save enough (younger) people. President Obama was on the right track with the task force mammogram recommendations but then he acquiesced to the backlash.maribel chaveznoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-14589317962900867532011-04-24T04:57:02.457-07:002011-04-24T04:57:02.457-07:00I had a German chemist as an office partner for ma...I had a German chemist as an office partner for many years and he once decided to shop for prices on a dental procedure he needed. He asked his dentist for the billing codes for his recommended procedure and called three other dentists and asked them for prices for those codes. No dice of course, he would have to come in and get a complete evaluation to get a price. This is like shopping for TV&#39;s at stores that charge you a couple of hundred bucks at the door to come in and browse whether or not you buy anything. Some market.<br /><br />If you are young and want to save money on dental care it&#39;s a fact that a couple of plates will cost you far less to maintain over your lifetime than your natural teeth. Anyone who hasn&#39;t opted for this cost saving procedure is not allowed to talk to me about market solutions. They are not thinking rationally about health care. They are emotionally attached to some expensive to maintain body parts.<br /><br />Richard ALeslyhttp://www.blogger.com/profile/07498084836642346802noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-85623523714419623192011-04-23T13:18:45.925-07:002011-04-23T13:18:45.925-07:00How can you really know it&#39;s the last month of...How can you really know it&#39;s the last month of life until it&#39;s over?Connie Boydnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-6591043465101119682011-04-23T13:01:17.370-07:002011-04-23T13:01:17.370-07:00Interesting but your illustration that demand for ...Interesting but your illustration that demand for gas is inelastic is not a strong argument. In fact, gas consumption changes significantly in response to price. People start driving less, buy more efficient cars, take public transportation (except in places where no public transit exists). Yes, they still have to drive, but there are many modifications a driver can make that do not affect their ability to keep living. Heck, they can even walk or bike everywhere (again with some constraints for those living in rural areas or those who cannot walk long distances). Medical care is much less elastic, especially as &quot;consumers&quot; really don&#39;t understand which services are vital and which are optional. It&#39;s not reasonable to ask someone to give up use of their arm because surgery is expensive.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-19903124534683237862011-04-23T12:58:33.522-07:002011-04-23T12:58:33.522-07:00To Russ Nelson: That was a pretty low blow. He&#...To <b>Russ Nelson</b>: That was a pretty low blow. He&#39;s offering his observations on the economically motivated behaviors that he perceives in his workplace and in patients/consumers. He might be wrong in a &quot;macro&quot; sense, or propose faulty solutions but his observations are valid and should be respected.<br /><br />By the same token, even though you&#39;re an economist, your doctor probably asks you about your symptoms and your response to his/her treatments, and uses that information to make a more informed decision about your further treatment.<br /><br />Dialogue is most productive when it can go both ways and all opinions are heard.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-75622508639340964812011-04-23T12:49:41.048-07:002011-04-23T12:49:41.048-07:00You&#39;re a doctor. I&#39;m an economist. Should ...You&#39;re a doctor. I&#39;m an economist. Should I be treating your wife&#39;s cancer? Then why do you announce your ignorant opinions on economics?Russ Nelsonhttp://www.blogger.com/profile/17586083637805291834noreply@blogger.comtag:blogger.com,1999:blog-20056539.post-39336708145816999472011-04-23T07:55:17.848-07:002011-04-23T07:55:17.848-07:00Came here from Sullivan. Sharp post - well done.
...Came here from Sullivan. Sharp post - well done.<br /> <br />I&#39;ve arrived at the conclusion that Capitalism - while a wonderful system for production on most things - has serious issues when it comes to the human being.<br /> <br />Medicine, education, religion, family - none of these fit particularly well within a market model (which corresponds with your point on asymmetrical information - take a look at approval numbers for &quot;all schools&quot; vs. &quot;your child&#39;s schools&quot;, for example). The overwhelming number of doctors/nurses, teachers, or priests/imams/rabbis I&#39;ve met don&#39;t have professions as much as &quot;life&#39;s work.&quot; I sure don&#39;t know any parents who procreated on the basis of the profit motive.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-20056539.post-5831812310434045022011-04-23T07:30:42.191-07:002011-04-23T07:30:42.191-07:00This is very well written and I agree with pretty ...This is very well written and I agree with pretty much all of it. I also live in the PNW and I am a glad there are docs like you in our local community.<br /><br />And to those of you complaining about his economic credentials, hopefully Doctors will continue to be way more reliable than our esteemed economists.ExPatBritnoreply@blogger.com